HIIG Creative Solutions (HCS) Leadership Team

With a strong background in insurance and group medical stop loss, the HCS management team brings industry leadership to every claim. We’re proud to bring this level of knowledge to our clients nationwide.

SUZI JOHNSON, MANAGING DIRECTOR

Suzi Johnson began her career in 1974 in Little Rock, Arkansas at Union Life Insurance Company, processing group and individual medical claims.

Early in her career, she was provided the opportunity to be involved with one of the first TPAs in Arkansas, Fewell and Associates, where she served as the VP of Claims and Administration from 1980-1988. In 1988, Johnson developed a claim division for an MGU, Guarantee Insurance Resources (GIR). She served as VP of Claims and ended her career with GIR as Chief Operating Officer. In this position, she was responsible for developing policy and procedures for claims, reserving, audits, as well as involvement of excess claims and reserving. Then, in 1994, Johnson founded SJ Solutions and performed audits on behalf of MGUs and carriers.

In 1999, Johnson joined HCC Life Insurance (HCCL), where she served for 15 years as Senior Vice President of Claims. The company had acquired and consolidated several MGUs. Johnson was brought in to develop consistent claim policies and procedures, hire, train, represent HCCL in litigious matters and validate reserving for actuarial purposes. During her tenure, HCCL grew from approximately $100 million to $800 million in annualized premiums. From internal audits by the holding company to PricewaterhouseCoopers’ Sarbanes–Oxley (SOX) audits and more, all audits were exemplary.

In 2017, Johnson was named Managing Director of HCS and oversees all operations. She brings a proven career in the insurance arena, especially with group medical stop loss, and with successfully starting new operations.

KAREN WHALEY, VICE PRESIDENT OF CLAIMS

Karen Whaley began her career in the health insurance field in 1981, where she worked at a third party administrator as a claims adjudicator. Karen continued working at various TPAs and quickly moved up in the industry with job duties such as Auditor, Trainer, Supervisor and Claims Manager. In 1999, Karen began her carrier in medical stop loss while working at a MGU. In 2000, she joined HCC Life Insurance Company (HCCL) as a Claims Supervisor. She managed specific auditors, provided ongoing training to auditors and focused on excellent customer service. In 2005, she moved to J. Smith Lanier Administrators as a Claims Manager. She managed medical/dental claims and customer service departments, created new procedures and filed reinsurance claims. She is credited with decreasing the claims backlog and phone calls.

In late 2006, Whaley returned to HCCL to assume the title of Claims Quality Training Supervisor. She was responsible for supervising and training new Specific Claims Auditors, developing training documentation, serving as a back-up supervisor for the claims department and assisting in the merger of claim staff and systems with two HCCL acquisitions.

In 2015, she joined Creative Risk Underwriters, where she served as the Director of Claims.

Whaley now serves as HCS’ Vice President of Claims, bringing more than 37 years of experience in medical insurance, which includes 17 years of experience in specific/aggregate stop loss claims. Whaley is a highly organized individual and is committed to providing exceptional customer service.

NICOLE AUTILIO, RN, CCM, AATMC, DIRECTOR OF CLINICAL ASSESSMENT

Nicole Autilio began her medical career as a licensed practical nurse at Kindred Transitional Care and Rehabilitation Center while she attended school to become a Registered Nurse. She later acted as a Registered Nurse for Herrick House and Mount Auburn Hospital’s cardiac/telemetry unit. She gained experience as a case manager at Excella Home Health. In 2014, Autilio became a clinical liaison nurse for New England Life Care based at Massachusetts General Hospital, where she served as the onsite liaison providing clinical assessment of patients referred by the member hospital for home infusion therapy, coordinated VNA visits and provided clinical updates.

In 2015, Autilio became the lead insurance risk consultant for QBE Accident & Health. She was responsible for ensuring effective risk management, performed reviews, assessed new business, and reviewed large claims/disclosure to identify known and potential risk. She also assisted underwriters in the evaluation and assessment of clinical and claims data to identify and quantify known and potential risks through accurate reporting. She was also charged with developing strong client, TPA and vendor relationships. In 2016, Autilio obtained her certification in Case Management (CCM) and Advanced Achievement in Transplant Management Certification (AATMC).

In September, Autilio leveraged her experience to become the Director of Clinical Assessment for HCS. She brings with her more than 10 years of management experience and a diverse clinical background across the continuum of care.